Healthcare Provider Details

I. General information

NPI: 1033054200
Provider Name (Legal Business Name): GRACE HENDRIX PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 A C SKINNER PKWY BLDG 100
JACKSONVILLE FL
32256-6932
US

IV. Provider business mailing address

7751 BELFORT PKWY STE 350
JACKSONVILLE FL
32256-6951
US

V. Phone/Fax

Practice location:
  • Phone: 904-516-3737
  • Fax: 904-516-3738
Mailing address:
  • Phone: 904-363-7453
  • Fax: 904-363-7453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9121655
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: